BRADNER: State level politics surrounding health care law are anything but simple

INDIANAPOLIS - While the politics surrounding the health care law may be cut-and-dry, the policy questions surrounding its implementation on the state level — and commanding attention in Indiana's governor's race — are anything but simple.

That's why the usual rhetoric from the two leading candidates for governor doesn't hold up when it comes to debating how to run a health insurance exchange.

Republican U.S. Rep. Mike Pence often says that the next governor needs to "be willing to say 'yes' to Indiana and 'no' to Washington, D.C." Democratic former Indiana House Speaker John Gregg, meanwhile, decries "Washington-style" policies at every turn.

It logically follows that the two of them would prefer Indiana to operate its own exchange, consolidating as much decision-making authority as possible at the state level rather than leaving it in the hands of federal bureaucrats — right?

Not quite.

No, Pence would prefer that Indiana refuse to do anything to implement the health care law, a stance that would lead to the state defaulting into a federally-facilitated exchange. Gregg says he wants a partnership that would give the state some input but still leave most of the work establishing the exchange to the federal government.

Here's how Pence — the front-runner by an 18-percentage point margin, according to a recent Indiana Chamber of Commerce poll — explained the difference between his federalist rhetoric and his health care position in a letter to Gov. Mitch Daniels:

"Operating our own exchange might seem like a way around the health care law's onerous regulations right now," he wrote, "but the way the regulations are written, the federal government will be hyper-regulating state-based exchanges. This would reduce the state of Indiana to a branch office of the Department of Health and Human Services."

His position is a stark contrast with the one staked out by Kentucky Gov. Steve Beshear, a Democrat who has ordered his state to set up its own exchange.

"We will work closely with insurers, providers, consumers and other groups to develop a robust, responsive, and user-friendly portal that will help Kentuckians find the coverage that best suits their needs," he said in a July statement.

What does all of this — the debate between a state-run exchange, a federally-facilitated one, or a partnership that lets the state make a couple decisions — mean for the people who will actually try to use these systems in 2014?

Unfortunately, the short answer is it's too soon to tell.

There are decisions to be made regarding what small businesses are allowed to pay and offer their employees, what plans insurance companies can offer, how users will be able to navigate the exchanges and more.

What the debate over a state-run exchange versus a federal exchange is about is who will make those decisions. However, since we don't yet know what a federal exchange would look like, we can't know how state leaders might want to set up something different.

The argument against a state-run exchange is that setting one up at this stage would be a rash rush to judgment. The argument for it is based on the assumption that state leaders will better know what's needed and more responsive when changes are necessary.

One thing is clear: This is a debate that has very little to do with where the candidates stand on President Barack Obama's health care law itself.

Suggesting that the job a governor does implementing the law on the state level should depend on how he feels about the national policy is just as silly as suggesting that Republicans who opposed the stimulus ought to turn taxpayer dollars away from their state was.

It's a complicated issue — one that doesn't easily lend itself to campaign-trail rhetoric, but that is important to consider nonetheless.